Correspondence

Keywords

Author

developmental disabilities, parenting, cognition, Linguistic Inquiry and Word Count (LIWC)

dcarroll@uwsuper.edu

David W. Carroll

Department of Psychology, University of Wisconsin-Superior, Superior, WI

Cognitive and Emotional Language Use in Parents of Children with Developmental Disabilities

Abstract

The present study examined cognitive and emotional language use in narratives of parents of children with Down syndrome (n = 78) versus other developmental disabilities (n = 45). It was hypothesized that parents of children with Down syn-drome would make more references to positive emotions and fewer references to negative emotions and cognitive processes. Narratives were examined using the Linguistic Inquiry and Word Count (LIWC) software. Parents of children with Down syndrome made fewer references to tentativeness, insight, cau-sation, and sadness than parents of children with other devel-opmental disabilities. The results suggest that diagnostic uncer-tainty increases cognitive processing and negative emotions in parents of children with developmental disabilities. Limitations of the analysis of published narratives were discussed.

Parenting a child with a developmental disability may evoke a number of different responses. These may include anger (Atkinson et al., 1995), depression (Orsmond, Lin, & Seltzer, 2007), and sorrow (Mallow & Bechtel, 1999) as well as more positive responses (Trute & Hauch, 1988). The variability of parental responses may be due to a number of factors, including the social support system, the coping styles of the parent(s), and the nature of the childs disability. For example, Florian and Findler (2001) found that the marital adaptation of mothers of children with cerebral palsy was influenced by the size of the familys support network. Regarding cop-ing style, Seltzer, Greenberg, Floyd, and Hong (2004) found better adjustment in parents who adopted a coping style in which they flexibly adjusted their goals in response to their childs disability.

Relatively less is known about how parents adapt to family life with children with different kinds of disabilities. Perry, Harris, and Minnes (2004) compared mothers and fathers of children with one of five types of developmental disabil-ity (Down syndrome, fragile X syndrome, Rett syndrome, autism, and unknown etiology) on the Moos and Moos (1981) Family Environment Scale. Although there were few group differences, Perry et al. reported an intriguing finding that increased diagnostic ambiguity was associated with lower levels of perceived family harmony. Similarly, Goldberg, Marcovitch, MacGregor, and Lojkasek (1986) found greater family stress in families of children whose developmental disability was of unknown etiology relative to children with Down syndrome.

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Cognitive and Emotional Language Use 89In this paper, I examine how different develop-mental disabilities may lead to different paren-tal experiences. First, I discuss the use of nar-ratives as a means of investigating cognitive, emotional, and social phenomena and review representative studies using this approach. Next, I examine the differences that may exist between parents of children with Down syn-drome versus parents of children with other developmental disabilities. I then report a study that examines narratives written by the two groups of parents. Finally, I examine the impli-cations of the current findings with respect to the current literature on families with children with developmental disabilities.

The study of narratives has attracted strong interest within psychology for some time. Bruner (1986) has suggested that stories are, along with arguments, one of the two natu-ral modes of thought. Cognitive psychologists have examined the structure of a well-designed story and its effects on memory (Mandler, 1984), and other scholars have studied how sto-ries emerge in children (McCabe & Peterson, 1991) as well as the role of narratives in psycho-therapy (Labov & Fanshel, 1977). More recently, McAdams and colleagues have explored how individuals create meaning by constructing life stories (McAdams, 2001), focusing in particular on turning points in lives (McAdams, Josselson, & Lieblich, 2001).

In this study, I examined parental narratives from a quantitative perspective. In recent years, quantitative analysis of narratives has yielded important insights into how individuals struc-ture their experience (Mehl, 2006; Tausczik & Pennebaker, in press). Pennebaker, Francis, and Booth (2001) developed the Linguistic Inquiry and Word Count (LIWC) software. LIWC receives text files as input and produces mea-sures of several dozen linguistic and psycho-logical variables. Most measures are the per-centages of various word types (e.g., articles, emotion words) in the text. Previous studies have explored the relationships between LIWC measures and variables such as personality (Pennebaker & King, 1999), gender (Newman, Groom, Handelman, & Pennebaker, 2008) and depression (Stirman & Pennebaker, 2001).

Carroll (2008) examined cognitive and emotion-al responses of parents of children with devel-

opmental disabilities and parents of typically developing children using the LIWC. Carroll collected samples from books written by par-ents of children with disabilities and parents of healthy children and found some surprising differences between the two groups of books. Parents of children with disabilities made more references to optimism and fewer references to anger than parents of typically developing chil-dren. In addition, they referred to family and home less often than parents of typically devel-oping children. There were also significant differences in the use of pronouns. Parents of children with disabilities used the first person singular and second person plural less often and the first person plural and the third person more often than parents of typically develop-ing children. In other words, they talked about themselves less and their children more.

Of particular interest to the present study, these two groups of parents differed on cog-nitive and emotional variables. With regard to cognitive variables, the parents of children with developmental disabilities referred more often to certainty and less often to tentative-ness. Parents of children with developmental disabilities made more references to optimism and fewer to anger. One limitation of this study was that it included parents of children with many different kinds of disabilities. If diagnos-tic uncertainty influences parental experience, then we might expect to see cognitive and emo-tional differences in the narratives of parents of children with relatively clear-cut versus more ambiguous diagnoses.

In this study, I examine the narratives written by parents of children with Down syndrome (hereafter, PCDS) and parents of children with other developmental disorders (hereafter, PCDD). Down syndrome was singled out for two reasons. First, unlike many other develop-mental disabilities, Down syndrome has a rela-tively clear diagnosis and prognosis. Diagnosis may be confirmed through genetic studies shortly after birth, and health issues (e.g., heart problems, articulation issues) are relatively well understood. In contrast, conditions such autism, pervasive developmental disorder, and cerebral palsy are associated with a wider range of out-comes and thus, for the parents, greater levels of uncertainty. In addition, Down syndrome, compared to other genetic conditions that may

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90 carrolllead to disabilities in children, is relatively com-mon. Thus, resources are available for families of children with Down syndrome whereas sup-port systems for families dealing with less com-mon childhood conditions may be more diffi-cult to secure.

Two hypotheses were tested in this study. First, it was hypothesized that PCDS authors would make fewer overall references to cognitive pro-cesses than PCDD authors. The assumption was that diagnostic uncertainty may increase cogni-tive processing and thus may lead to more fre-quent references to solving problems, drawing conclusions, and related cognitive processes. In particular, it was expected that parents of chil-dren with Down syndrome would make more references to certainty and fewer to tentative-ness. Second, it was hypothesized that PCDS authors would make more references to posi-tive emotions and fewer to negative emotions than PCDD authors. The assumption is that the relatively greater uncertainty in the DD group would be experienced as negative emotions.

Method

Participants

Seventy-eight PCDS narratives and forty-five PCDD narratives were included in the study. Sixty-two of the PCDS narratives were taken from Soper (2007) and sixteen from Klein and Schive (2001). The forty-five PCDD narratives were from Klein and Schive (2001). I chose the Soper book due to the large number of narra-tives related to Down syndrome and the Klein and Schive because it provided narratives relat-ed to a number of different conditions.

The forty-five PCDD narratives included seven instances of autism, six of cerebral palsy, and two of spina bifida. The remainder included a wide range of disabilities such as cri du chat syndrome, Angelman syndrome, fragile X syn-drome, Marfan syndrome, and craniosynos-tosis. Several of the contributions dealt with disabilities that were not clearly diagnosed or identified.

All but three of the narratives from the two books were included in the study. Two authors contributed to both volumes, and I used only

one story from each author. One other contri-bution was excluded because it was coauthored by two parents and thus did not represent the voice of a single parent.

Most of the essays in Klein and Schive (2001) and all of the essays in Soper (2007) were writ-ten by mothers. The two sets of narratives were comparable in terms of length and linguis-tic complexity. The mean length of the essays was 1154 words (SD = 479 words) for the PCDS group and 1037 words for the PCDD group (SD = 385 words). The PCDS group averaged 15.1 words per sentence (SD = 2.8 words) where-as the PCDD group averaged 15.5 (SD = 2.5 words). The percentage of words captured by the LIWC dictionary, a measure of how com-mon the language used in a text is, was 90.1% for the PCDS group (SD = 2.4%) and 90.4% for the PCDD group (SD = 2.3%).

Table 1. Examples of LIWC variables

Variable Examples

Cognitive

Causation because, conclude, effect, hence

Insight consider, grasp, know, think

Discrepancy ideal, normal, should, wish

Inhibition abstain, block, constrain, hesitate

Tentative guess, maybe, perhaps, possible

Certainty absolute, always, never, sure

Inclusion along, both, each, we

Exclusion but, except, unless, without

Positive Emotions

glad, happy, silly, sweet

Negative Emotions

Anxiety afraid, nervous, obsess, tense

Anger fight, hate, kill, temper

Sadness alone, cry, grief, sad

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Cognitive and Emotional Language Use 91Procedure

Narratives were scanned, cleaned up, and submitted to the most recent version of LIWC (Pennebaker, Booth, & Francis, 2007). LIWC receives text files as input and produces mea-sures of about 80 linguistic and psychological variables. Most measures are the percentages of various word types (e.g., articles, emotion words) in the text.

Twelve LIWC variables were selected for this study: positive emotions, the three subcatego-ries of negative emotions (anxiety, anger, and sadness) and the eight subcategories of cogni-tive mechanisms (insight, cause, discrepancy, tentativeness, certainty, inhibition, inclusion, and exclusion). Examples of the twelve vari-ables are shown in Table 1.

Results

Means for each LIWC variable for each author were calculated. Although some of the LIWC categories had low base rates, the distributions of the categories were sufficiently similar to normal distributions to justify parametric tests.

A one-way multivariate analysis of variance (MANOVA) examined the effects of family type on the 12 LIWC variables. The MANOVA was significant, F(12, 110) = 5.41, p = .001. Tests of between-subjects effects (see Table 2) indicated that the PCDS group made fewer references to insight (p = .001), tentativeness (p = .001), exclu-sion (p = .001), cause (p = .034), and sadness (p = .021). The groups did not differ on positive emotions or certainty.

Discussion

The results support the cognitive hypothesis. PCDS authors made fewer references than PCDD authors on four of the eight cognitive variables in LIWC. PCDS authors made fewer references to tentativeness (depend, hope, indefi-nite), insight (discover, explain, understand), and exclusion (exclude, not, versus). In addition, PCDS authors made somewhat fewer references to cause (hence, infer, reason). It appears that PCDD authors are engaging in considerable cognitive effort to understand the nature of their childs disability and the effect of the disability on their family. In particular, these parents seem

Table 2. LIWC measures for Down syndrome (DS) and other developmental disability (DD)

DSa DDb

Variable M SD M SD F d

Insight 2.74 .78 3.54 .91 26.86** .94

Cause 1.24 .45 1.43 .54 4.59* .38

Discrepancy 2.08 .74 2.08 .71 .02 .00

Tentativeness 1.99 .62 2.76 .91 31.64** .99

Certainty 1.54 .59 1.44 .47 1.04 .19

Inhibition .57 .32 .62 .28 .77 .17

Inclusion 5.96 1.26 5.90 1.32 .06 .05

Exclusion 1.94 .68 2.53 .85 17.74** .77

Positive Emotions

3.77 1.01 3.96 1.12 .97 .18

Anxiety .55 .31 .62 .44 .83 .16

Anger .25 .25 .34 .26 3.41 .35

Sadness .54 .35 .73 .55 5.44* .41a n = 78 b n = 45 * p < .05 ** p < .001

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92 carrollto be focused on the tentative nature of their childrens diagnoses.

The exclusion subcategory deserves special mention. Suedfeld (1985) has suggested that individuals may cope with negative life events by a process of differentiation (recognizing dif-ferent dimensions or perspectives on a given situation) and integration (the recognition of trade-offs, syntheses and other ways of inte-grating different points of view). Suedfeld and Bluck (1993) examined letters written by indi-viduals who had experienced positive and neg-ative life events and found an increase in dif-ferentiation and integration following the neg-ative events, although not the positive events. The prevalence of exclusion words in the PCDD authors may reflect recognition of the ways in which their child or their family may differ from other children or families, as a first step in constructing a different type of family.

The results provide partial support for the emo-tion hypothesis. PCDS authors made fewer ref-erences to sadness, although the groups did not differ with respect to anxiety, anger, or positive emotions. The results are consistent with Perry et al. (2004) and Goldberg et al. (1986) in sug-gesting that diagnostic ambiguity may lead to more negative experiences in parents of chil-dren with developmental disabilities.

These results support and extend Carroll (2008). Carroll found that parents of children with developmental disabilities expressed greater amounts of certainty and less tentativeness than parents of typically developing children. In addition, parents of children with disabili-ties expressed more optimism and less anger. However, Carrolls study did not differenti-ate between different types of disabilities. It appears that PCDS authors in the present study are most similar to the parents of children with disabilities studied by Carroll (2008), as both display relatively low levels of negative emo-tions and tentativeness. In contrast, the PCDD authors in the present study appear to be more cognitively active and less emotionally positive than the parents studied by Carroll (2008).

This pattern of findings may be considered in light of recent scholarship on the narrative study of lives. McAdams and Bowman (2001; see also McAdams, 2001) have examined turn-

ing points in lives, emphasizing the themes of redemption. Redemption sequences occur when individuals are able to turn negative life events into more positive outcomes. For example, the death of ones father may lead a family to become closer or an exhausting workload may cause an individual to recognize the need for more balance in ones life.

There are some resemblances between the redemption sequences found by McAdams and Bowman and the narratives studied here. For example, one PCDS narrative concludes:

But as we head into year two of Aidans life, Ive long since realized that our luck did not run out the day he was born. Not at all. In many ways, our lives have been transformed. We have found loving support from people who used to be strangers. We look at the world differently and consider ourselves lucky to be able to. We have an appreciation for a slower pace; we take greater delight in each small step. And we have a new-found understanding of the preciousness of all people. (Dwight, 2007, p. 9)

A similar redemptive theme is apparent in a PCDD author, albeit with a tinge of sadness:

The sorrow, although unwelcome, can be a path-way to an unconditional love that grows from a realization of the intrinsic beauty of each childs existence. We parents of children with disabili-ties can feel fine about ourselves when we grasp this and give up superficial achievement-based values. For Tariq, as for most children with dis-abilities, there has been no miracle, despite all my striving and wishes. I was powerless to change him, but he has changed me so much that I have no idea who I would be without him. I am okay without the baseball and the model airplanes. I did get a close, warm relationship with my son-and a touch of wisdom. No way would I give that up. Still, there are times that I wont deny wish-ing we could sit down and really talk. (Naseef, 2001, p. 209)

McAdams and Bowman also emphasize that redemption sequences are most commonly found in individuals with a high degree of generativity; that is, these are individuals who wish to contribute in positive ways to the next generation (McAdams, Diamond, de St. Aubin, & Mansfield, 1997). It may be that both PCDS

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Cognitive and Emotional Language Use 93and PCDD authors choose to share their stories to assure others that the experience of parent-ing a child with a developmental disability has its joys as well as its challenges.

The present results may be helpful in identify-ing appropriate support systems for families with different types of disabilities. Considerable research has indicated that the provision of an appropriate support system may play a role in how parents respond to children with develop-mental disabilities (Perry, 2004). However, the types of support systems may vary with the type of disability. Parents with children with Down syndrome may primarily need informa-tion regarding the diagnosis and prognosis of the syndrome. Fortunately, there are a number of resources available to assist parents.

In contrast, parents of children with less clear-cut diagnoses such as autism or pervasive developmental disorder may need different and more extensive support. These parents may receive conflicting messages from dif-ferent professionals as well as information in the popular media that may be misleading or wrong (see, for example, Fitzpatrick, 2009). The present study suggests that these parents may spend considerable effort in trying to determine the cause of their childs disability as well as the therapeutic alternatives that may help their child. The stress associated with this effort may lead to the relative frequency of negative emo-tions found in this study. These parents may benefit from therapeutic opportunities that are targeted at the stressful nature of their situa-tion. Further study of the role of uncertainty in parental experience is warranted.

There are several limitations to this study. Although PCDD authors may differ as a group from PCDS authors, there is obviously consid-erable variability in the experiences of parents within the former category. The present sample of narratives precluded any analyses within this category, but future research on a larger num-ber of narratives should examine this issue. In particular, the experience of parents of children with well-defined but less common disabilities, such as Angelman syndrome, would be inter-esting to pursue.

Another limitation is that this study was not directly comparable to Carroll (2008), due to

the changes in the LIWC. For example, using the earlier edition of the LIWC, Carroll (2008) found that parents of children with develop-mental disabilities tended to be more optimistic than parents of typically developing children. The newer version of the LIWC does not include subcategories of positive emotions. In addition, the inclusion and exclusion variables are con-sidered as subcategories of cognitive words in the 2007 but not the 2001 version of the LIWC.

It should also be mentioned that word count approaches, such as the LIWC, are not sensitive to linguistic context. Sentences such as My situation makes me angry and However, I seldom get angry will be coded identically for the anger category. Similarly, the LIWC does not provide information about the distinction between I was angry and The doctor grew angry with me. Thus, the LIWC provides a measure of how frequently words in a given category appear but not how they function in particular sentences.

Finally, the titles of the two books used in this study suggest that they were written to pro-vide inspiration for parents of children with developmental disabilities. The narratives in these books might not be representative of the experience of all parents of children with dis-abilities. More generally, there may be selective pressures for publishers to present positive or uplifting stories about families of children with developmental disabilities.

In sum, these results suggest that the experi-ence of parenting a child with a developmental disability depends to a significant extent on the nature of the disability. Parents of children with Down syndrome are faced with considerable challenges but these challenges are relatively more clear-cut than those faced by parents of children with less clear diagnoses. It may be useful to explore how the support systems for different groups of parents may need to differ as well.

Author Note

An earlier version of this paper was presented at the Association for Psychological Science convention in San Francisco, May, 2009.

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94 carroll

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